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cant be good
Oct 26, 2003

Effect of HAART on Survival in HIV Patients After Seroconversion

HAART was introduced in 1997. In the current study, researchers aimed to assess the continuing effect of this treatment on survival and progression to AIDS after HIV-1 seroconversion.

The investigators used Cox models to estimate the effect of calendar year on time to AIDS and death in 22 cohorts of people from Europe, Australia, and Canada who had seroconverted.

Retrospective and prospective data were used. They compared the effects of age at seroconversion, exposure category, sex, and presentation during acute HIV-1 infection pre-1997 (pre-HAART), in 1997-98 (limited use of HAART), and 1999-2001 (widespread use of HAART).

Study Results

Of 7740 seroconverters, 2000 (26) had died. Compared with pre-1997 data, the hazard ratio (HR) for death fell sharply to 047 in 1997, dropping further to 016 in 2001. Correspondingly, the proportion of person-time on HAART increased from 22 in 1997 to 57 in 2001.

By contrast with the pre-HAART era, injecting drug users had significantly higher mortality in 1999-2001 than did men infected through sex with men. However, whereas pre-1997 the risk of AIDS was higher in those aged 45 years or older at seroconversion than in people who were 16-24 years, in 1999-2001 there was little evidence of a difference in risk by age; No such attenuation in the effect of age on survival was observed (p=063).

Although survival times have continued to improve between 1997 and 2001, they have not matched the early reductions in risk of death or disease progression noted soon after the introduction of HAART.

The changing balance between increased frequency of resistance, which leads to higher rates of treatment failure, variation in the circulation of subtypes, availability of new drugs or drug classes, and other changes in clinical management policies make the longer-term effect of HAART difficult to predict.

Increased survival for people with HIV infection means that non-HIV causes of death are becoming increasingly important, and high quality information on cause of death is vital to assess the effect of interventions against HIV infection.

Longer follow-up of persons with known duration of HIV infection is crucial to assess whether there is a persistent leveling off in the reduction in mortality rates, or even whether mortality will begin to rise again, and to accurately estimate whether older persons do still have a poorer survival with the availability of HAART.

10/20/03

Reference K Porter and others (The Cascade Collaboration). Lancet 362: 1267-1274. October 18, 2003.

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Response from Dr. Wohl

That's right, no one is immortal.

Death from HIV related causes are down so, now many people with HIV living in areas where they can enjoy the benefits of HAART (and their doctors) need to be cognizant of age-related causes of disease. Unfortunately, persons in Africa and Asia and other resource poor locales do not have this luxury. DW



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